Abstract
BackgroundThe rate of decline in cardiovascular disease (CVD) mortality has lessened nationally. How these findings apply to specific states or causes of CVD deaths is not known. Examining these trends at the state level is important to plan local interventions.MethodsWe analyzed CVD mortality trends in Minnesota (MN) using the U.S. Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER). Trends were analyzed by age, sex, type of CVD and location of death.ResultsCVD mortality rates in MN declined in 2000–2009 and then leveled off in 2010–2018, paralleling national rates. Age- and sex-adjusted CVD mortality decreased by 3.7% per year in 2000–2009 (average annual percent changes [AAPC]: -3.7; 95% CI: − 4.8, − 2.6) with no change observed in 2010–2018. Those aged 65–84 years had the most rapid early decline in CVD mortality (AAPC: -5.9, 95% CI: − 6.2, − 5.7) and had less improvement in 2010–2018 (AAPC: -1.8, 95% CI: − 2.2, − 1.5), and the younger age group (25–64 years) now experiences the most adverse trends (AAPC: 1.2, 95% CI: 0.7–1.8). Coronary heart disease (CHD) and cerebrovascular disease had the largest relative decreases in mortality in 2000–2009 (CHD AAPC: -5.2; 95% CI: − 6.5,-3.9; cerebrovascular disease AAPC: -4.4, 95% CI: − 5.2, − 3.6) with no change 2010–2018. Heart failure (HF)/cardiomyopathy followed similar trends with a 2.5% decrease (AAPC 95% CI: − 3.5, − 1.5) per year in 2000–2009 and no change in 2010–2018. Deaths from other CVD also decreased in the early time period (AAPC: -1.6, 95% CI: − 2.7, − 0.5) but increased in 2010–2018 (AAPC: 1.9, 95% CI: 0.5, 3.3). In- and out-of-hospital death rates improved in 2000–2009 with a slowing in improvement for in-hospital death and no further improvement for out-of-hospital death in 2010–2018.ConclusionConcerning CVD mortality trends occurred in MN. In the most recent decade (2010–2018) mortality from all CVD subtypes plateaued or even increased. CVD mortality among the younger age groups increased as well. These data are congruent with adverse national trends supporting their generalizability. These adverse trends underscore the urgent need for CVD prevention and treatment, as well as continued surveillance to assess progress at the state and national level.
Highlights
In the United States (US), total cardiovascular disease (CVD) mortality declined steadily between the 1970s and 2016 [1, 2]
Age- and sex-adjusted CVD mortality decreased by 3.7% per year in 2000–2009 (AAPC: -3.7; 95% Confidence interval (CI): − 4.8, − 2.6) with no change observed in 2010– 2018 (AAPC: 0.0; 95% CI: − 1.5, 1.5; Table 1)
Men had a higher rate of CVD mortality than women; both groups had a similar decline in the rate of CVD mortality in 2000–2009 with no further improvement in 2010
Summary
In the United States (US), total cardiovascular disease (CVD) mortality declined steadily between the 1970s and 2016 [1, 2]. The rising prevalence of obesity and diabetes mellitus (type 1 and 2) over the same period suggested that if these risk factors had been controlled, gains would have been even greater. Against the backdrop of these adverse risk factor trends, in 2011, the number of deaths from all CVD, heart disease, and stroke in the US began increasing, resulting in a slow down in the decline of corresponding mortality rates. The rate of decline in cardiovascular disease (CVD) mortality has lessened nationally. How these findings apply to specific states or causes of CVD deaths is not known. Examining these trends at the state level is important to plan local interventions
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